Yet ANOTHER aliyah blog -- but one I hope that will be source of hope for myself and inspiration for others.

Friday, December 21, 2012

Jumping through the hoops of the health care system in Israel...

I go in for my surgery on Tuesday and I am nervous as
hell. The process of getting my surgery
to be paid for by my insurance, here in Israel, has been rather daunting. Just so you all understand: I am from the US and I moved to Israel just
over a year ago. In the US even though
health insurance is ridiculously expensive, and does not cover enough of costs,
it is a remarkably streamlined process which can be effectuated months in
advance and can take a few days to get set.
Here the process is NOT streamlined in the least and everything takes
place at the "last minute".
That can be quite hairy for someone who may not have enough moolah to cover
anything that may not be covered. So
here is how it panned out for me.

It was about six months ago that I initiated the process of
diagnosis and getting recommendations for correcting the issue. As soon as I learned it would take surgical
intervention, I agreed to the surgery and began to put the wheels into motion
to enable it. First, I had to wait to
receive a date for the surgery. That
took about a month of waiting and it was scheduled for December 25th - four
months out from the time I received the date.
I immediately asked what the procedure was for getting it covered by my
kupah (health insurance). I was told
that since my surgeon is a "private practitioner" I would need to
contact the "Sharap" office at Hadassah Hospital, where my surgery would
take place, and the Sharap office would be in touch with my kupah and then they
would contact me. But, I was told I
would not know anything until a few days before the surgery!!! At that point I explained that I needed to
know at the very least how much my share of the cost would be, due to the fact
that my funds are tied up in the States and it would take me some time to
arrange for the release of the funds to pay for it. So Sharap understood and contacted my kupah
and got me the info. In effect, they
"neogiated" with my kupah about this.
Ok, fine.

Last week, I was contacted by Sharap and told that my kupah
was refusing to cover the surgery because I was not a participant in their Gold
plan for a full year -- I would be shy by SIX DAYS on the day of the
surgery! That is by THEIR reckoning, not
by MY reckoning – what happened is this:
when I arrived in Israel, just off the plane, I was met by an agent from
the Jewish Agency and told to choose a health insurance provider. I had done some research before I arrived and
I chose Maccabi. Then, a week later I attended
the NBN Klita Fair in Jerusalem. I knew
there would be a booth there for Maccabi and I would be able to select a
supplemental health coverage plan. I
went to the Maccabi booth, sat with a Maccabi representative and chose Maccabi
Magen Zahav. I filled out the forms, and then went about my way, feeling secure
in the knowledge that I was covered. I had been assured that all my info would
be “put into the system” the very next day.

A couple of months later, I was ill and needed prescription
medicine. I went to the Maccabi Pharmacy
to fill the prescription. The price
seemed rather steep and I said as much to the pharmacist. His reply to me was “If you were a Magen
Zahav participant it would not be so expensive”. I told him that I am indeed a participant in
Magen Zahav. He double checked and no I was not. So I went down to the Maccabi
office to find out what was going on.
There, I spoke to a lovely woman named Nochi (just so you know, I have
found EVERYONE in the Maccabi office in Modi’in to be exceedingly nice and
helpful). She confirmed that I was NOT a
participant and there was no indication that I had ever signed up. But she signed me up right then and there. I erroneously thought my participation would
be counted as retroactive from when I signed up.

So, back to Sharap informing me that Maccabi would not cover
it due to my being six days shy of a full year of participation in Magen
Zahav. The Sharap office suggested that
I needed to go into the Maccabi office and ask them for a “kitzur” of my
account (shortening of it) to allow me to have the surgery and for them to
cover it. This I did, that very evening.
(Yes, they have evening hours!) There, I
was told I needed to write a letter explaining all this and requesting the
kitzur.

With the help of friends I wrote a letter which I then sent
to Maccabi Surgery. It was an excellent
letter, even my surgeon said so when I shared it with him. It did the trick and Maccabi agreed to cover
the surgery. Great! Or so I
thought. That same day, I was contacted
by Maccabi and told that they will NOT cover the surgery because the doctor I
chose is a “private practitioner”. I was
kind of surprised (although not so much because now, I was used to expecting
the other shoe to drop!). I told them
that I had addressed that issue by dealing the Sharap office which had already
been in touch with Maccabi and had already negotiated the fees. It was to no avail. So, I explained this to my surgeon, not
knowing what else to do. Maccabi wanted
me to choose another doctor – and I would NOT do that. My surgeon is the top doctor in the field and
I trust him implicitly. I would not
choose any other doctor.

Well, he came to my rescue.
He told me that another doctor who will be assisting him would be the
name we would give to Maccabi. Maccabi
would cover him. So, I did give that
name to Maccabi and sure enough they agreed to cover him. I suspect this is a game that is routinely
played by the doctors and insurance companies here.

But now, Maccabi requires a new hafnaya (referral) naming
the new doctor. Again, I turned to my
surgeon who told me “No problem, we will get a hafnaya to them on Sunday.” Mind you, my surgery is now four days away
and on Sunday will be two days. When I
was told initially that everything gets arranged at the last minute, I realize
now that was the honest truth!!

Personally, I think it is a very bad way of doing
things. An individual who is facing
major surgery, scary and painful surgery is already stressed out about that and
working hard to be calm, relaxed, and positive – which is crucial when one is
about to undergo anesthesia and surgery – does not need the added stress of
worrying about whether or not the surgery will be covered by their kupah at the
very last minute! It is something that
should be worked out WELL in advance of any surgery that is PLANNED.

In any case, it appears that everything is working out as it
should and as always I give my thanks to Hashem for His hand in it. I know he is orchestrating much of this for
me!

"We are making or have made aliyah on HaShem's command. He trusts us to use our GOD-given intelligence and developing emuna (rollercoastering wavering and strengthening emuna included) to make our lives work. Examine and rearrange your priorities to fit with the goal HaShem has for
us: bitachon in Av HaRachamim. Take it one baby step at a time. Gradual growth is more likely to last than sudden changes too hard to bear all at once." -- Yocheved Golani